Medication reconciliation is an important component of strategies for preventing adverse events after hospital discharge. Studies show that comprehensive medication interventions (including medication reconciliation) by hospital-based pharmacists can reduce adverse events and readmissions in older patients. This Canadian study sought to evaluate whether medication reconciliation and education by community pharmacists could also achieve the same aims for recently discharged patients. This nonrandomized study used propensity score analysis to evaluate outcomes of patients who received medication reconciliation and review of medication adherence performed by community pharmacists during a dedicated visit. Researchers found that patients receiving the service had a reduction in readmissions and death. The magnitude of benefit was small overall, but it was larger in patients who were filling a new prescription for a high-risk medication. Although the nonrandomized design precluded firmer conclusions, this study indicates that community-based medication reconciliation and review may be a promising strategy for reducing adverse events after discharge.

This article describes results from the 2018 American Society of Health-System Pharmacists national survey regarding inpatient pharmacy practice. The authors report several trends including the development of opioid stewardship programs with pharmacist involvement and a higher percentage of hospitals with pharmacists working across a greater variety of clinical areas.

Medication errors occur frequently in the outpatient setting and can lead to patient harm. A common scenario is one in which a patient is prescribed multiple medications, does not know what each one is for, and takes them incorrectly. Medication safety experts have advocated that prescribers include indications on prescription labels to enable patients and pharmacists to check the bottle in order to remember a medication's purpose. Investigators examined more than 4 million outpatient prescriptions from a single institution and found that only 7.4% of prescriptions included an indication. Medications for symptoms like pain, nausea, and anxiety were much more likely to have indications than medications for chronic diseases. Internal medicine physicians, whose patients are more likely to take multiple medications, wrote indications 6% of the time. A PSNet perspective explored how community pharmacists can use medication indications and other tools to ameliorate medication-related harm.

This retrospective study of voluntary safety reports examined medication errors related to electronic prescribing. Researchers found that errors related to electronic prescriptions accounted for a small proportion of medication errors and were of low severity. They suggest that safety monitoring and feedback continue to be needed for electronic prescribing.

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This simulation study compared performance of pharmacists in preparing chemotherapy under conditions of increasing workload, as measured by the number of doses needed. Investigators found that as the volume of work increased, so did the risk of errors. This finding highlights the need to ensure working conditions promote safety.

Medication errors associated with compounding are well-described. As recommended by the Institute for Safe Medication Practices, health care organizations are implementing technology to improve the safety and efficiency of compounding processes. In this study of eight hospitals in the United States (four with such technology and four without), researchers examined compounding medication errors, time spent on compounding workflow processes, and cost per compounded medication. They found that the hospitals with compounding technology–assisted workflow experienced a higher rate of medication errors, shorter medication preparation time, and lower costs compared to hospitals using manual compounding processes.

Researchers examined employee perceptions of safety culture before and after implementation of a pharmacy services call center designed to reduce interruptions across nine community pharmacies. They found that pharmacies with the call centers reported a 9.3% overall improvement in patient safety after implementation.

This article describes the development and validation of a scoring tool to identify patients most at risk for adverse drug events. The authors suggest that an external validation study is needed to determine whether this tool accurately predicts which patients could benefit most from pharmacist consultation during hospitalization.

This retrospective analysis examined the economic outcomes of a pharmacist-led prior authorization drug request program. Researchers calculated that pharmacist adjudication led to savings in drug costs and also avoided costs related to potential adverse events that were intercepted by pharmacists. They recommend wider use of pharmacist-led formulary management.

Medication errors are a common cause of preventable harm in long-term care. In this controlled pilot study, a pharmacist embedded in a long-term care facility was able to identify and intervene on potential medication problems, primarily by preventing inappropriate dosage form modification (i.e., crushing tablets or opening capsules to facilitate drug administration).

In this retrospective study, researchers found that implementation of an inpatient pharmacist-led pain management service achieved reductions in high-risk opioid medication use, total opioid use, and adverse drug events associated with oversedation from opioids. Patient satisfaction scores also improved after the intervention.

The unintended consequences of computerized provider order entry and clinical decision support are well-described. Researchers conducted focus groups with pharmacists and physicians at two acute care hospitals in England and found that both computerized provider order entry and clinical decision support increased different aspects of workload for pharmacists and providers while electronic messaging capability yielded some improvements in interprofessional communication.

Pharmacists enhance medication safety in hospitals and ambulatory settings. The authors interviewed pharmacists about their experience implementing a dashboard that allowed them to identify and provide feedback regarding hazardous medication prescribing in primary care. A WebM&M commentary describes other pharmacy-led efforts to make prescribing safer.

Older adults frequently encounter medication-related harm, which may result in preventable hospitalizations. In six Hawaiian hospitals, hospital pharmacists identified older patients at risk of medication problems and assigned them to a community pharmacist who coordinated their medications across prescribers for 1 year after discharge. This post-hoc analysis of the intervention found that most medication-related harm occurred in the community (70%) rather than the hospital and that the intervention successfully reduced community-acquired harm.

In this qualitative study, researchers followed the progress of the improvement work taken on by 10 English community pharmacies that participated in improvement workshops over a 1-year period. Using a behavioral change framework, they were able to describe the pharmacies' progress in their activities as well as identify particular organizational factors facilitating improvement work.

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This report describes a clinical skills course for student pharmacists. Researchers created vignettes relating to inpatient medication dispensing and asked the students to identify errors of omission and commission. The authors conclude that this exercise accomplished the goal of fostering patient safety in pharmacy practice.

Look-alike and sound-alike medications are known to increase the risk of adverse drug events. Using Veterans Affairs administrative data on prescriptions filled for look-alike and sound-alike medications, researchers found that the potential for medication errors was high, but the actual error rate based on chart review was low.

Pharmacy robots are now commonly used in hospitals for dispensing medications. Conducted at a Spanish hospital, this study found that use of pharmacy robots reduced medication dispensing errors and improved staff efficiency. The role of a pharmacy robot in a serious medication error is explored in a book that examined the effects of technological change on the health care system.

Many ambulatory electronic health records cannot communicate to pharmacies that medications should be discontinued. In a nationally representative sample, nearly 1% of new prescriptions had discontinuation instructions for other prescriptions embedded within them, a workaround that creates inefficiencies and new safety hazards. A recent interview with Michael Cohen, President of the Institute for Safe Medication Practices, discussed this and other safety concerns that community pharmacies face.

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Combination medications are frequently used to improve adherence, but they may also contribute to medication errors. Using pharmacy claims data, researchers found that the prescribing of antihypertensive fixed-dose combination medication was associated with a greater risk of therapeutic duplication.